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Traumatic brain injuries (TBI) are very serious injuries and understanding the etiologies of brain damage from a workers’ compensation perspective requires a fundamental understanding of the interplay between neurology and psychiatry. TBI indutrial injuries will usually require a medical-legal (QME) evaluation by a neurologist and a psychiatrist or psychologist given the types of disabilities that may arise from a TBI or a mild traumatic brain injury (mTBI).
Chapter 13 of the American Medical Association (AMA) Medical Guides, 5th Edition addresses potential cranial nerve damage and peripheral nervous damage corresponding to a TBI. Generally, the cranial nerve one is the most affected nerve, however, it is generally not properly tested by primary treating physicians (PTPs) and we always work with PTPs to ensure that cranial nerve 1 is tested appropriately. To a lesser extent, cranial nerve 7 (involving the facial nerve for motor strength) and cranial 3 (involving the pupil area) are also impacted by a TBI. Further, Chapter 12 of the AMA Guides addresses problems corresponding to ambien vision (side vision); and Chapter 13 of the AMA Guides addresses the vestibular aspects of an injury. Other chapters of the AMA Guides also touch on injuries caused by TBIs that we will address in a future blog post.
It should be noted that often times valium is used over time to treat TBIs, however, extensive usage can result in a decrease in memory — in these instances, it may be useful for a QME to review Chapter 11 of the AMA Guides as it relates to one’s functional efficiency and audibility.
In terms of determining the whole person impairment (WPI) and level of permanent disability, our position is that the addition of disabilities under the Kite case is the appropriate approach to determine the WPI because of the vision, hearing, and disequilibirum concurrency that is found in most serious TBIs.
Lastly, to briefly address medical treatment, it should be noted that the Administrative Director has incorporated the Medical Treatment Utilization Schedule (MTUS). When an employee is injured at work, he or she is entitled to receive reasonable and necessary medical treatment to cure or relieve the injury. The Medical Treatment Utilization Schedule (MTUS) is a set of regulations found in title 8, California Code of Regulations section 9792.20 through 9792.27.23 that contain medical treatment guidelines and rules for determining what is reasonable and necessary medical care. The MTUS is based on the principles of evidence-based medicine. That means treatment decisions are guided by recommendations supported by the best-available evidence. Of note, there are two types of drugs — (a) there are exempt drugs that don’t require authorization but need to be prescribed pursuant to the MTUS; and (b) non-exempt drugs that require authorization by Utilization Review like most other drugs. A link to the MTUS Drug List can be found below:
https://www.dir.ca.gov/dwc/MTUS/MTUS-Documents/Drug-List/January-2019/DRUG-LIST-V4-Addendum-One.pdf
Additional blog posts on TBI and mTBIs will be addressed in the future.
Authored by Steve Franco, Esq.
